| BackgroundBoth rheumatoid arthritis(RA) and systemic lupus erythematosus (SLE) arechronic systemic inflammatory autoimmune disease.Their pathogenesis still very notclear, think to be concerned with the dysfunction of dendritic cells, T lymphocyte and Blymphocyte. Recent study displays that vitamin D can not only regulate calcium andphosphorus metabolism that prevent osteoporosis,but can also influence dendritic cells,T and B lymphocyte that modulate the immune system.It may play an important role inthe maintenance of the immune homeostasis and sickness condition control in patientsof RA and SLE,but the specific variation tendency and clinical significance of vitaminD in patients of RA and SLE have not been clear.ObjectivesTo determine the serum levels of25-hydroxyvitamin D[25(OH)D] in patients ofRA and SLE, and to assess the association of25(OH)D with disease activtiy,inflammatory cytokines and bone damage in RA and the association of25(OH)D withdisease activtiy, organ damage and autoantibodies in SLE, respectively.MethodsThe study included130patients of RA,60patients of SLE,60patients of kneeosteoarthritis(KOA) and110healthy controls. Serum25(OH)D, interleukin (IL)-17andIL-23levels were detected by enzyme-linked immunosorbent assay (ELISA). The detail clinical, laboratory and radiographically information of the RA and SLE patients wererecorded.Results1. Serum levels of25(OH)D in RA/SLE group and control group:1) Serum levels of25(OH)D were markedly lower in RA group than control group[(17.25±6.24)ng/ml vs (23.17±6.38)ng/ml,P<0.01], while cases of25(OH)Dinsufficiency/deficiency in the RA group were more than the control group(P<0.01).2) Serum levels of25(OH)D were markedly lower in SLE group than control group[(16.32±5.54)ng/ml vs (22.28±6.93)ng/ml,P<0.01], while cases of25(OH)Dinsufficiency/deficiency in the SLE group were more than the control group(P<0.01).3) No significant difference in25(OH)D serum concentrations was found betweenpatients of RA and SLE.4) Serum levels of25(OH)D were markedly higher in RA group than KOA group[(17.25±6.24)ng/ml vs (15.08±5.15)ng/ml，P<0.05].2.25(OH)D and selective clinical indicators in RA and SLE patients:1) Negative correlation was detected between25(OH) D levels and the following:duration of morning stiffness, tender joint count(TJC),swollen joint count(SJC),degree of pain that scored by visual analogue scale(VAS), health assessmentquestionnaire(HAQ), blood platelets and erythrocyte sedimentation rate(ESR) ofthe patients with RA(both P<0.05), respectively. There were no relationshipbetween25(OH) D levels and C-reactive protein(CRP), rheumatoid factor andanti-CCP antibodies, respectively.2) Positive correlation was detected between25(OH) D levels and plasma albumin(both P<0.05). Negative correlation was detected between25(OH) D levels and urine proteins of24hour(sP<0.05). There were no relationship between25(OH) Dlevels and blood routine indexes including white blood cells, lymphocytes,redblood cells, hemoglobin and platelets, immunoglobulin G, serum globulinlevel,ESR,CRP,C3and C4, respectively.3.25(OH)D and disease activity in RA and SLE patients:1)25(OH) D levels were significantly lower in group with moderate and severedisease activity than in group with stable or low disease activity (both P<0.05).Insufficiency/deficiency of25(OH)D was the risk factor for disease activity bymultiple regression analysis(β=-0.457,95%CI:-0.210～-0.100，P<0.001)。.2)25(OH) D levels were significantly lower in group with moderate or severe diseaseactivity than in group with stable or low disease activity [(13.70±3.83)ng/ml vs(18.94±5.80)ng/ml,P<0.01].Insufficiency/deficiency of25(OH)D was the riskfactor for disease activity by multiple regressionanalysis(β=-0.513,95%CI:-0.933～-0.355,P<0.001).4.25(OH)D and inflammatory cytokines in RA patients: Negative correlation wasdetected between25(OH) D levels and interleukin (IL)-17(β=-0.359, P<0.01)andIL-23(β=-0.365, P<0.01), respectively.5.25(OH)D and organ damage in SLE patients:25(OH)D level was influenced byphotosensitization, arthritis and kidney damage(both P<0.05);No significantdifference in25(OH)D serum concentrations was found between SLE patients withbutterfly erythema, discoid lupus, canker,serositis, blood system and nervoussystem diseases and without these clinical manifestations. 6.25(OH)D and autoantibodies in SLE patients: No significant difference in25(OH)Dserum concentrations was found between SLE patients with Antinuclear antibodies,anticardiolipin antibodies, anti-Sm, anti-SSA, anti-SSB, anti-ribosomal P andanti-C1q antibodies, and without these autoantibodies, respectively.There wassignificant difference in25(OH)D serum concentrations between SLE patients withanti-double-stranded DNA, anti-AunA, anti-AHA and anti-U1RNP antibodies, andwithout these autoantibodies (respectively, both P<0.05).7.25(OH)D and bone damage in RA and SLE patients:1) No statistically significant association was observed between25(OH)D andradiographic progression of RA. BMD was classified into three groups:normal,osteopenia and osteoporosis and significant differences of serum25(OH)D levelswere found by compared with each group (P<0.01).Normal serum25(OH)D levelwas a protection factor for RA-induced osteoporosis by Logistic regression analysis(OR＝0.898，95%CI0.830－0.972, P<0.01).2) No significant differences of serum25(OH)D levels were found among the threegroups of normal BMD, osteopenia and osteoporosis in SLE patients.8. Influence of therapy on25(OH)D in RA and SLE patients:1) Patients of RA was classified into three groups: untreated group, informaltreatment group and regular treatment group, there were significant differencesamong the three groups(F=4.819，P=0.010).2) No significant difference in25(OH)D serum concentrations was found betweenfirst visit patients (without treatment)and subsequent visit patients of SLE(P>0.05). Negative correlation was detected between25(OH) D levels and dailyaverage of glucocorticoid in a month(r＝-0.355,P＝0.005). Conclusions1. Significantly low25(OH)D level was found in patients with RA and SLE.2. Negative correlation were detected between25(OH) D level and disease activity ofRA, expression of inflammatory cytokines like IL-17and IL-23could play a role.3. The relationship between vitamin D and bone erosion of RA patients still remainvague while there was negative relation between25(OH)D values and BMD.4.25(OH)D level in SLE patients could be influenced by photosensitization,arthritis,kidney damage.5. Expression of autoantibodies including anti-double-stranded DNA, anti-AunA,anti-AHA and anti-U1RNP antibodies in patients of SLE could be influenced by25(OH)D. |
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